A popular sugar substitute is facing fresh scrutiny after researchers found that people with higher levels of xylitol in their blood experienced greater risks of heart attack, stroke and other major cardiovascular events. However, the findings do not prove that xylitol caused those events.

The research was presented at the ESC Cardiology Congress in Germany. It found an association between higher blood concentrations of xylitol and an increased risk of major adverse cardiovascular events, also known as MACE.

According to the National Institutes of Health, xylitol is a sugar alcohol commonly used as a low calorie sweetener and sugar substitute. It is frequently added in higher amounts to foods, drinks, chewing gum and dental care products.

Researchers followed two large study cohorts that included more than 17,700 Canadian and British participants. The two groups were observed over different periods, allowing researchers to examine the association between xylitol levels and cardiovascular events over time.

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During six years of follow up, participants in the Canadian Longitudinal Study on Aging with the highest xylitol levels had a 57% higher risk of death, myocardial infarction or stroke related to cardiovascular events. That risk was calculated in comparison with participants who had the lowest levels.

Researchers also examined a British group from the European Prospective Investigation into Cancer. Over 30 years, participants with the highest xylitol levels had an 18% greater risk of major adverse cardiovascular events.

Both cohorts showed evidence of a dose dependent association. In other words, higher concentrations of xylitol in the blood corresponded with higher rates of cardiovascular events among the participants studied.

The elevated risks remained after researchers adjusted for other factors, including age, gender, body mass index, hypertension, diabetes and lipid levels. Even so, the observational design prevents the study from establishing that xylitol directly caused the cardiovascular events.

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The findings follow earlier research indicating that xylitol can enhance the ability of platelets to form clots, according to Dr. Marco Witkowski. Witkowski, the study presenter, is from Charité University Hospital in Berlin, Germany.

"Artificial sweeteners are consumed by people who think they are healthier than sugar, and they are generally regarded as safe by regulatory agencies," Witkowski said in a statement. He said the findings show that further studies are warranted as the amount of xylitol in products continues to increase.

The researchers emphasized that additional work is needed to confirm the results. The report also did not establish whether elevated xylitol levels in the blood necessarily came from dietary consumption.

Xylitol can be produced naturally in the body as part of glucose metabolism, according to the report. Therefore, the study cannot determine from blood levels alone how much xylitol participants consumed through foods, drinks or other products.

Dr. Aseem Malhotra, a cardiologist and public health campaigner based in London, was not involved in the research. "These disturbing findings with [a] plausible mechanism of xylitol increasing cardiovascular risk should be taken very seriously," he told Fox News Digital.

Malhotra also described what he has observed among his own patients. "As a practicing cardiologist, I see many patients suffering from anxiety and palpitations that resolve as soon as they stop taking artificial sweeteners."

He said one of the most important dietary changes for reducing cardiovascular risk is to "unsweeten your sweet tooth." Malhotra added, "That’s why I advise all my patients to avoid all processed sugars and artificial sweeteners for six weeks to break the addiction."

The findings raise questions about the cardiovascular safety of a sweetener widely regarded as a sugar alternative.

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